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Affordable Care Act Basics Flashcards

7 cards from real CACS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Affordable Care Act Basics flashcards as text

  1. A 45-year-old applicant lost job-based coverage 40 days ago. Are they eligible for a Special Enrollment Period (SEP)?

    Answer: Yes, loss of job-based coverage triggers a 60-day SEP window

    Loss of qualifying health coverage triggers a 60-day SEP, so the applicant at 40 days is still within the eligibility window.

  2. Which of the following is a qualifying life event that triggers a Special Enrollment Period?

    Answer: Moving to a new ZIP code or county that affects plan availability

    Moving to a new coverage area that changes available plan options is a qualifying life event that triggers a 60-day SEP.

  3. What does 'actuarial value' measure in a health insurance plan?

    Answer: The percentage of total covered medical costs the plan pays on average

    Actuarial value is the average percentage of covered medical costs that the plan pays for a standard population, used to define metal tier levels.

  4. A consumer enrolled in a Silver plan receives Cost-Sharing Reductions. What happens if they switch to a Gold plan mid-year through a SEP?

    Answer: They lose CSR benefits, since CSRs only apply to Silver plans

    CSRs are only available on Silver plans; switching to any other metal tier eliminates access to cost-sharing reduction benefits.

  5. What is the 'employer mandate' under the ACA?

    Answer: Requirement for large employers (50+ FTEs) to offer affordable coverage or pay a penalty

    The ACA employer shared responsibility provision requires applicable large employers with 50 or more full-time equivalent employees to offer affordable, minimum-value coverage or face penalties.

  6. For APTC purposes, what is considered 'affordable' employer-sponsored insurance under the ACA?

    Answer: Employee-only premium does not exceed a set percentage of household income (9.02% for 2024)

    Employer coverage is considered affordable if the employee-only premium does not exceed the IRS affordability threshold (9.02% in 2024) of household income.

  7. Which federal law made it illegal for health insurers to impose lifetime dollar limits on essential health benefits?

    Answer: The Affordable Care Act (ACA)

    The ACA banned lifetime and unreasonable annual dollar limits on essential health benefits in all non-grandfathered health plans.